A cooking skills intervention for long-term weight loss in young adults with intellectual disabilities: Rationale and design for a randomized trial

Young adults with intellectual disability (ID) are an underserved population with a high prevalence of obesity, obesity-related health conditions, and reduced ability to complete instrumental and basic activities of daily living (I/ADLs). After leaving the structured environment of public school, many young adults with ID spend more time at home or in day programs, begin living more independently, or enter the workforce. These transitions may increase reliance on fast or processed foods and reduce opportunities for physical activity, contributing to accelerated weight gain. Previous research has demonstrated clinically meaningful short- and long-term weight loss (18-24 months) in adults with mild-to-moderate ID and overweight/obesity using multi-component behavioral interventions. However, similar approaches have not achieved long-term success in younger adults with ID. Limited evidence suggests that cooking-skills training is feasible and may improve diet quality in young adults with ID, yet no adequately powered trial has tested its impact on long-term weight loss in this population. This randomized trial will evaluate whether adding a cooking-skills program to a multicomponent weight-management intervention improves long-term weight loss in young adults with ID and overweight/obesity. We will randomize 114 participants (1:1) to a standard weight-loss program or a standard weight-loss program plus cooking skills sessions for an 18-month intervention with a 6-month no-contact follow-up period. The primary aim is to compare weight loss at 18 months; Secondarily, we will compare between-arm changes in body composition, cardiometabolic biomarkers, I/ADLs, cooking skills, and caregiver strain. Exploratory analyses will examine mediators and moderators of weight change.